Peripheral microcirculatory alterations are associated with the severity of acute respiratory distress syndrome in COVID-19 patients admitted to intermediate respiratory and intensive care units.

BACKGROUND: COVID-19 is primarily a respiratory disease; however, there is also evidence that it causes endothelial damage in the microvasculature of several organs. The aim of the present study is to characterize in vivo the microvascular reactivity in peripheral skeletal muscle of severe COVID-19 patients. METHODS: This is a prospective observational study carried out in Spain, Mexico and Brazil. Healthy subjects and severe COVID-19 patients admitted to the intermediate respiratory (IRCU) and intensive care units (ICU) due to hypoxemia were studied. Local tissue/blood oxygen saturation (StO2) and local hemoglobin concentration (THC) were non-invasively measured on the forearm by near-infrared spectroscopy (NIRS). A vascular occlusion test (VOT), a three-minute induced ischemia, was performed in order to obtain dynamic StO2 parameters: deoxygenation rate (DeO2), reoxygenation rate (ReO2), and hyperemic response (HAUC). In COVID-19 patients, the severity of ARDS was evaluated by the ratio between peripheral arterial oxygen saturation (SpO2) and the fraction of inspired oxygen (FiO2) (SF ratio). RESULTS: Healthy controls (32) and COVID-19 patients (73) were studied. Baseline StO2 and THC did not differ between the two groups. Dynamic VOT-derived parameters were significantly impaired in COVID-19 patients showing lower metabolic rate (DeO2) and diminished endothelial reactivity. At enrollment, most COVID-19 patients were receiving invasive mechanical ventilation (MV) (53%) or high-flow nasal cannula support (32%). Patients on MV were also receiving sedative agents (100%) and vasopressors (29%). Baseline StO2 and DeO2 negatively correlated with SF ratio, while ReO2 showed a positive correlation with SF ratio. There were significant differences in baseline StO2 and ReO2 among the different ARDS groups according to SF ratio, but not among different respiratory support therapies. CONCLUSION: Patients with severe COVID-19 show systemic microcirculatory alterations suggestive of endothelial dysfunction, and these alterations are associated with the severity of ARDS. Further evaluation is needed to determine whether these observations have prognostic implications. These results represent interim findings of the ongoing HEMOCOVID-19 trial. Trial registration ClinicalTrials.gov NCT04689477 . Retrospectively registered 30 December 2020.

Influence of proximity to a geographical range limit on the physiology of a tropical bird.

1. Species' geographical ranges can be limited by a variety of biotic and abiotic factors. Physiological challenge in response to unsuitable environmental conditions can establish limits to geographical ranges. 2. We studied the physiology of Song Wrens (Cyphorhinus phaeocephalus) across their geographical range on the isthmus of Panama, an area characterized by a strong rainfall gradient. Wrens are common on the Caribbean slope of the isthmus where annual rainfall is greatest, but wren abundance declines towards the south as annual rainfall declines. Song Wrens are completely absent from the driest third of the isthmus. 3. We searched for the existence of a physiologically induced distribution limit by measuring body condition (an integrative measure of energy balance), hematocrit (% packed red blood cells in a given blood sample), and corticosterone levels (CORT, a steroid hormone that regulates the availability of energy and the endocrine stress response) in males and females. We caught birds by luring them into nets when they responded to playback of conspecific song. 4. Wrens living in drier habitat near the geographical range edge were significantly more likely to have abnormally low hematocrit scores. Baseline CORT levels were negatively associated with rainfall in one of our three best-fit path models, indicating potential energetic challenge in some individuals. Maximum CORT levels during a 60-min period of restraint correlated significantly only with sex, being higher in females. Birds with the poorest body condition lived at the dry end of the gradient. Birds on the wet end of the gradient responded fastest to conspecific song. 5. Environmental conditions vary across geographical ranges and may influence the physiological conditions of organisms, thereby enforcing limits to species' distributions. Highly specialized species, such as birds of the rain forest understory, may be especially susceptible to environmental variation associated with changing climatic conditions.

Disentangling the effects of environment and life-history stage on corticosterone modulation in Costa Rican rufous-collared sparrows, Zonotrichia capensis costaricensis.

This study explores the factors that influence modulation of baseline corticosterone levels and the hypothalamo-pituitary-adrenal cortex (HPA) axis response to stress in Costa Rican rufous-collared sparrows (Zonotrichia capensis costaricensis). Individuals in our study population vary in their timing of breeding and molt. Thus, at multiple times of the year, we were able to investigate how the HPA axis changes with life-history stage (breeding, molt) and the interaction of season and life-history stage. Season explained most of the variation in corticosterone data. During the dry season, males had higher baseline corticosterone levels and both females and males had a higher stress response, regardless of breeding or molting condition. Breeding did not significantly affect corticosterone levels in either males or females. There was no direct effect of molt on corticosterone levels in males or in females, but there was a significant interaction between season and molt for male baseline corticosterone levels and HPA axis responsiveness. Baseline corticosterone levels were not correlated with body condition, suggesting that body condition is not an explanatory factor for HPA axis change. Our data indicate that environmental conditions may affect how the HPA axis in birds is modulated during different life-history stages. They also emphasize the importance of studying species with diverse life cycles and seasonality.

Diarrhea in young children associated with Escherichia coli non-O157 organisms that produce Shiga-like toxin.

OBJECTIVE: To assess the clinical manifestations and incidence of infection associated with Shiga-like toxin-producing Escherichia coli (SLTEC). STUDY DESIGN: Children with diarrhea within a defined geographic area during a 12-month period were examined for the presence of SLTEC in their stools by polymerase chain reaction with the use of primers that were complementary to sequences of Shiga-like toxins types I and II and to other virulence factors. RESULTS: There were 13 SLTEC infections among 468 children with diarrhea. Besides Shiga-like toxin sequences, the virulence genes eae and EHEC-hly were found in 10 isolates; these isolates were categorized as enterohemorrhagic E. coli (EHEC). Only 2 of 13 isolates were of the O157 strain. All reported cases occurred in summer (June through September) with the exception of one case in April. The infections were sporadic, and the infected children lived in rural and urban areas. Three infections in children with disabilities were hospital acquired. The majority of children had watery diarrhea, two had bloody diarrhea, and one had mild hemolytic-uremic syndrome. The overall incidence of SLTEC infection was 12.5 hospitalized children per 100,000 children less than 16 years of age. CONCLUSIONS: The most frequent clinical manifestation of SLTEC infection was watery diarrhea indistinguishable from other forms of infectious diarrhea. The shift from the O157 strain toward non-O157 SLTEC strains associated with diarrhea, also observed in German patients with hemolytic-uremic syndrome, points to a change in the epidemiologic features of SLTEC-associated disease. Testing for non-O157 SLTEC should be considered in children with diarrhea without a recognized cause.